Decreasing Door-to-Analgesia Time: Increasing Use of Sickle Cell Pain Management Pathway.

Area of Science:

• Pain Management
• Quality Improvement
• Pediatric Hematology

Background:

• Sickle cell disease patients frequently experience acute pain crises requiring emergency department visits.
• Current care often involves delays in analgesia and invasive procedures.
• This project focused on improving timely pain management for sickle cell patients.

Purpose of the Study:

• To enhance the timely administration of pain medication for sickle cell disease patients.
• To increase adherence to an established pain management pathway.
• To promote the use of intranasal fentanyl as a first-line analgesic.

Main Methods:

• Implemented a quality improvement initiative with multiple interventions.
• Introduced a standard operating procedure for safe intranasal fentanyl use.
• Utilized electronic health record best practice advisories and educational materials.

Main Results:

• The time to pain medication administration decreased from a mean of 82.2 to 67.7 minutes.
• The median time to pain medication administration decreased from 65 to 59 minutes.
• While trends showed improvement, the change did not reach statistical significance (P = .2201).

Conclusions:

• Increased adherence to an intranasal fentanyl protocol reduced time to opioid administration for pediatric sickle cell patients.
• Standardized pain management pathways improve efficiency and equity in care.
• Findings support the benefits of established protocols for managing vaso-occlusive crises.